1. Field of the Invention
The present invention relates to endoscopic surgical methods and devices, and more specifically to methods and apparatus for manipulation of suture during endoscopic surgical procedures.
2. Description of the Related Art
Endoscopic suturing techniques and instruments have been developed in order to facilitate the suturing of tissue during endoscopic surgical procedures. The term xe2x80x9cendoscopyxe2x80x9d encompasses arthroscopy, laparoscopy, hysteroscopy, etc., and endoscopic surgery involves the performance of surgical procedures within a patient""s body through small openings as opposed to conventional open surgery through large incisions. Access to a surgical work site within a patient""s body is normally provided through one or more portals formed directly in the patient""s body or through one or more cannulas inserted into the patient""s body through small incisions. A chosen surgical procedure is carried out by a surgeon through the use of elongated instruments inserted through these cannulas and it often becomes necessary to suture selected tissue at the surgical work site.
Since the work site is only accessible through a small portal or cannula and since it is very difficult to tie sutures within the body, various devices and techniques have been developed to enable the surgeon to tie sutures endoscopically. For example, some procedures enable the surgeon to pass suture material through selected tissue, form a surgical knot extracorporeally and then move the knot with a knot pusher through the portal or cannula into position adjacent the desired tissue to be sutured. Some instruments used to pass the suture incorporate a hollow needle provided with some means, often a wire loop, to guide suture through the tissue pierced by the needle.
The present invention provides a hand instrument for retrieving suture within a patient. The suture retriever includes a shaft having a proximal end and a distal end. The distal end preferably terminates in a sharp tip. An opening in the shaft is disposed proximal to the distal end. A hinged jaw disposed on the shaft closes to capture suture within the opening in the shaft. A hand mechanism, preferably including finger loops, is disposed on the proximal end of the shaft for opening and closing the jaw.
Advantageously, the opening in the shaft is sized such that when the jaw is closed, suture captured within the opening by the jaw is allowed to slide freely as the suture grasper passes through soft tissue. Further, the opening preferably has a notched or sloped distal face, such that suture captured in the opening tends to slide more securely into the notch, away from the opening and the jaw.
For ease of use in various surgical situations, the instrument can be formed with a bend in the shaft, preferably proximal to the opening in the shaft. In particular for rotator cuff and glenoid labral repair, the shaft is bent upward at about a 15xc2x0 angle, and the opening is disposed on an upper side of the shaft. Bends in other directions and of differing degrees can be provided, such as side bends of 15xc2x0, 30xc2x0, 45xc2x0, and 60xc2x0. A straight shafted instrument also can be provided according to the present invention.
The instrument is provided so as to pass through a 6 mm cannula, the jaw closing flush with the outer surface of the shaft. Advantageously, the shaft is tapered toward the distal end such that the distal tip has a 2.5 mm diameter for ease of penetrating soft tissue.
A method of endoscopically retrieving suture disposed within a patient using the instrument of the present invention includes closing the jaw using the hand mechanism and inserting the shaft of the instrument distally into the patient. The tissue to be sutured is penetrated with the sharp tip, and the jaw is opened. The opening in the shaft is positioned proximate a piece of suture disposed in the patient, and the jaw is closed to capture the suture within the opening. As the instrument is retrograded, the captured suture is pulled back through the tissue, the suture being allowed to slide freely through the closed opening to prevent damage to the suture.
Preferably, the jaw can be locked in the closed position. Accordingly, during instrument insertion for example, it is not necessary for the surgeon to maintain hand position at the finger loops of the instrument as the instrument is guided through tissue. Most preferably, a finger-actuated locking mechanism secures the hand mechanism in a closed, open, or any given operating position.
Other features and advantages of the present invention will become apparent from the following description of the invention which refers to the accompanying drawings.